The treatment of patients with treatment-resistant depression poses a significant challenge within the public health system due to systemic barriers that make effective and low-cost drugs like ketamine unaffordable.
In an article published in the Australian & New Zealand Journal of Psychiatry, a team of medical researchers, including UNSW Sydney, Black Dog Institute, and The George Institute for Global Health, sheds light on the obstacles preventing affordable treatments from being accessible and proposes solutions to overcome these barriers.
The Challenge of Affordable Treatment
It has been over two decades since evidence emerged that generic ketamine could effectively treat depression.
However, public funding for research and patient access to this treatment has been slow, uncoordinated, and underfunded.
Furthermore, there has been a lack of commercial incentives to develop generic ketamine, and public-private partnerships have not been promoted.
As a result, there is a significant disparity in the accessibility and cost of ketamine-based depression treatments.
The patented intranasal s-enantiomeric ketamine formulation, Spravato, is priced between $500 to $900 per dose, while generic ketamine costs approximately $5 to $20 per dose.
Despite the effectiveness of generic ketamine at a fraction of the cost, it remains unapproved and underutilized due to regulatory and financial barriers.
One significant barrier is the need to monitor patients for at least two hours after each dose, whether it’s an injection with generic ketamine or nasal spray with Spravato.
As multiple doses are required for effective treatment, the cumulative costs can become prohibitive for many patients.
A Broader Issue
The challenges faced by ketamine are not unique, as the article predicts a similar fate for upcoming psychedelic-assisted psychotherapy treatments entering the mental health treatment arena.
Without systemic interventions, the underutilization of low-cost effective solutions may persist, leaving patients without access to treatments and potentially increasing healthcare costs.
The researchers propose a range of solutions, including:
- Providing Better Commercial Incentives: Encouraging pharmaceutical companies to support low-cost treatments.
- Boosting Funding for Research: Increasing funding for integrated and translational research.
- Reducing Regulatory Hurdles: Streamlining regulatory processes to facilitate approval and access to affordable treatments.
- Optimizing Clinical Trials: Making clinical trial procedures more efficient.
- Fostering Collaboration: Promoting collaboration across sectors and borders to advance affordable treatment options.
A Call for Collective Action
Professor Anthony Rodgers from The George Institute emphasizes the need for structural reforms and collective efforts to ensure affordability and accessibility in mental health care.
He calls on stakeholders from various domains to collaborate in creating an ecosystem conducive to repurposing off-patent medicines.
Remarkable Results with Ketamine
Co-author Professor Colleen Loo, a clinical psychiatrist with the UNSW-affiliated Black Dog Institute, highlights the remarkable results observed over the past 12 years using low-cost ketamine to treat severe depression resistant to other treatments.
To make this treatment accessible to patients, Medicare funding is necessary. However, systemic barriers, as explained in the article, obstruct this process.
There is a lack of commercial interest from pharmaceutical companies in listing low-cost, off-patent ketamine as a depression treatment, which prevents it from receiving Medicare funding.
Professor Loo underscores the need for government intervention to remove these barriers and allow for the use of low-cost ketamine to treat severe depression, as it aligns with society’s interests.
The authors and their institutions are planning an application to Medicare to have ketamine treatment for severe depression supported by the government health system.
In conclusion, this case study highlights the systemic barriers that hinder the affordability and accessibility of ketamine and potentially other low-cost treatments for depression.
It underscores the need for collaboration and reforms to ensure that effective treatments are available to patients in need.
If you care about depression, please read studies about how dairy foods may influence depression risk, and B vitamins could help prevent depression and anxiety.
For more information about mental health, please see recent studies that ultra-processed foods may make you feel depressed, and extra-virgin olive oil could reduce depression symptoms.
The research findings can be found in Australian & New Zealand Journal of Psychiatry.
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